The Hereditary Syndrome of Thrombocytopathia, Bleeding Tendency, Extreme Miosis, Muscular Fatigue, Asplenia, Headache, etc

SYNOPSIS
A new, autosomal dominantly inherited syndrome with a bleeding disorder was described in 1985 by Stormorken and his co-workers.1,2 In this multifaceted syndrome, there were the following integral components: thrombocytopathia, extreme miosis with Argyll Robertson-like traits, muscular fatigue, a tendency to spasms, asplenia, ichthyosis, dyslexia, etc.
Headache with migraine traits was also present in the family in all 4 generations in which this syndrome had been observed. Nasal and conjunctival bleeding were part of the headache picture in some of the individuals exhibiting the hemorrhagic syndrome. While the attack-related bleeding disturbances only involved family members who also suffered from the hemorrhagic syndrome, the headache per se may seem to behave differently: The affected son's headache seems to have developed into a headache with tension headache traits, whereas the other, unaffected, son's headache has common migraine traits. The familial headache which in earlier generations clearly had migraine traits, therefore, may be inherited independently from the hemorrhagic disorder. In other words, a migraine or migraine-like headache is most probably not an obligatory integral part of this syndrome. The thrombocytopathia in this disorder comprises abnormal serotonin storage, uptake, and release (Stormorken and co-workers, to be published).
The admittedly somewhat farfetched possibility also exists that the headache, although being similar to migraine, differs essentially from it and may be an expression of the serotonin aberration.     

Effect of 5-fluorouracil, mitoxantrone, methotrexate, and vincristine on the antibacterial activity of ceftriaxone, ceftazidime, cefotiam, piperacillin, and netilmicin

Using the checkerboard agar dilution technique, antibacterial activity and in vitro interactions of 4 antineoplastic agents and 5 antimicrobial drugs were examined against 56 strains of 7 bacterial species. 5-fluorouracil was found to inhibit all strains of Staphylococcus aureus and of Staphylococcus epidermidis at a concentration of 0.8 micrograms/ml or less. 84% of all gram-negative strains were inhibited synergistically when 5-fluorouracil was combined with beta-lactam antibiotics. Methotrexate and cefotiam were antagonistic in 42% of all combinations, especially when tested against Escherichia coli and Klebsiella pneumoniae.     

大麻素受体在成年大鼠脑组织中的分布特点

目的：研究大麻素CB1、CB2受体在成年大鼠脑组织的分布特点和规律,为进一步研究其功能打下基础。方法：用兔抗鼠CB1、CB2受体特异性抗体免疫组化染色,检测大鼠脑组织主要部位两种受体的表达分布情况。结果：CB1受体阳性细胞在脑组织有广泛大量的分布,大脑皮质、胼胝体、海马、基底核区及小脑浦肯野细胞层、脑桥等区域均有较明显表达。CB2受体阳性细胞的数量及分布部位与CB1受体表达基本一致,少数区域如胼胝体、小脑白质阳性细胞数相差较大,CB2受体明显多于CB1受体的表达。结论：大麻素CB1、CB2受体在成年大鼠脑组织均广泛分布,并在多数部位表达情况一致,少数部位存在表达程度差异,提示其在神经系统中参与了某些生理及病理作用。 关键词 CB1受体;CB2受体;大麻素;脑组织;大鼠     

Susceptibilities of non-Pseudomonas aeruginosa gram-negative nonfermentative rods to ciprofloxacin, ofloxacin, levofloxacin, D-ofloxacin, sparfloxacin, ceftazidime, piperacillin, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and imipenem.

Agar dilution MICs of 10 agents against 410 non-Pseudomonas aeruginosa gram-negative nonfermentative rods were determined. MICs at which 50 and 90% of the isolates were inhibited, respectively, were as follows (in micrograms per milliliter): sparfloxacin, 0.5 and 8.0; levofloxacin, 1.0 and 8.0; ciprofloxacin, 2.0 and 32.0; ofloxacin, 2.0 and 32.0; D-ofloxacin, 32.0 and > 64.0; ceftazidime, 8.0 and 64.0; piperacillin with or without tazobactam, 16.0 and > 64.0; trimethoprim-sulfamethoxazole, 0.5 and > 64.0; imipenem, 2.0 and > 64.0. With the exception of those for Stenotrophomonas maltophilia, Burkholderia cepacia, and Alcaligenes faecalis-A. odorans, agar dilution MICs for all strains tested were within 1 dilution of inhibitory (bacteriostatic) levels as determined by time-kill methodology.     

4种免疫法促甲状腺素检测系统结果的一致性评价王丹晨,禹松林,尹逸丛,国秀芝,程歆琦 ,邱玲,马超超,张瑞丽,刘茜,刘荔,高学慧,张葵 (中国医学科学院 北京协和医学院 北京协和医院检验科,北京100730)

目的 比较4种免疫法促甲状腺素(TSH)检测系统结果的一致性。方法 性能验证。收集2018年3至4月北京协和医院临床检测剩余新鲜血清标本共102份,用于方法学比对。参考CLSI EP15-A2 及EP9-A2方案进行精密度评价及方法学比对。分别采用雅培 i2000、贝克曼 DXI 800、西门子 ADVIA Centaur XP及罗氏 e601(标为A~D)全自动化学发光免疫分析仪及其配套试剂检测102份血清的TSH水平,应用Passing Babloke及Bland Altman进行比对分析。以0.27、5.33mU/L为医学决定水平,比较各检测系统的预期偏倚。 结果 A~D四种检测系统的精密度分别为1.7~3.3%、1.8~3.9%、0.7~2.3%、0.6~1.5%,中位数(P25 ~P75 )分别为1.898(0.518~4.809)mU/L、2.819(0.719~7.020)mU/L、2.502(0.692~6.888)mU/L、3.105(0.886~7.905)mU/L。4种检测系统回归方程的决定系数R2均>0.975,相关系数(r)在0.9935~0.9971之间,截距和斜率分别为0~0.06、0.59~1.15,其中B与C两个检测系统直线回归图斜率为1.02,截距为0,相关性最好；偏差图显示不同检测系统的百分偏倚在-48.1~17.3%,A与D检测系统偏倚最大为-48.1%,B与C检测系统偏倚最小为0.3%。4种检测系统在医学决定水平处的预期偏倚为-40.7~37.2%。结论 贝克曼与西门子TSH检测试剂一致性较好,罗氏、雅培TSH检测试剂与另外两家一致性存在差异。     

Comparative ototoxicity of ribostamycin, dactimicin, dibekacin, kanamycin, amikacin, tobramycin, gentamicin, sisomicin and netilmicin in the inner ear of guinea pigs

Nine aminoglycoside antibiotics, ribostamycin (RSM), dactimicin (DAC), dibekacin (DKB), kanamycin (KM), amikacin (AMK), netilmicin (NTL), tobramycin (TOB), gentamicin (GM) and sisomicin (SISO) were administered intramuscularly to guinea pigs for 4 weeks, and ototoxicity and drug concentration in the inner ear fluid were determined. RSM and DAC showed the weakest ototoxicity against the cochlea and vestibular organs. AMK and KM were more toxic to cochlea than vestibular organs. DKB, TOM, GM and SISO were equally toxic to vestibular organs and cochlea. NTL was more toxic to vestibular organs than cochlea. As judged from the pinna reflex response and hair cell damage in the cochlea, the order of auditory toxicity was the following: SISO greater than GM greater than TOB greater than AMK greater than DKB greater than KM greater than NTL, DAC RSM, whereas the vestibular toxicity was in the following order: SISO greater than GM greater than DKB greater than TOB greater than NTL greater than AMK greater than KM greater than DAC, RSM. RSM, causing the weakest ototoxicity, showed a low drug concentration in the inner ear fluid, while GM, causing severe ototoxicity, showed the highest drug level under the same conditions.     

Reviews of books, videos, CDs, audiotapes, web sites, and more, written by emergency nurses

Zimmermann PG. Philadelphia: Hanley & Belfus, 2002, 243 pp, ISBN 1-56053-529-6.     

品管圈在提高儿科住院患儿服药到口率中的应用

目的：探讨品管圈在儿科病房服药到口护理工作改进中的管理作用。方法：通过品管圈活动步骤,运用质量管理工具对儿科住院患儿服药不能到口的问题进行改进,并将改进前后状况进行比较讨论。结果：住院患儿服药到口率从42.5%提升到99.19%(P＜0.01)。结论：品管圈方法的应用提高了住院患儿服药到口率,提高了医护人员的团队精神,增强了护士的责任心,提升了护士的个人素质和自信心。     

In vitro activity of piperacillin, ticarcillin, mezlocillin, ticarcillin-clavulanic acid, aztreonam, ceftazidime, azlocillin, cefoperazone, and thienamycin against Pseudomonas aeruginosa

The in vitro susceptibility of 103 well-characterized strains of Pseudomonas aeruginosa to nine antimicrobial agents was assessed by means of the Kirby-Bauer disk diffusion assay and the microtiter minimal inhibitory concentration assay. The antimicrobials, from the most to the least active against P aeruginosa, were thienamycin greater than ceftazidime greater than piperacillin greater than azlocillin greater than cefoperazone greater than aztreonam greater than ticarcillin greater than ticarcillin-clavulanic acid greater than mezlocillin. The resistance patterns of the antimicrobial agents suggest that P aeruginosa resistant to a penicillin, cephalosporin, or aztreonam may be susceptible to thienamycin.     

Aluminum, iron, lead, cadmium, copper, zinc, chromium, magnesium, strontium, and calcium content in bone of end-stage renal failure patients.

BACKGROUND: Little is known about trace metal alterations in the bones of dialysis patients or whether particular types of renal osteodystrophy are associated with either increased or decreased skeletal concentrations of trace elements. Because these patients are at risk for alterations of trace elements as well as for morbidity from skeletal disorders, we measured trace elements in bone of patients with end-stage renal disease. METHODS: We analyzed bone biopsies of 100 end-stage renal failure patients enrolled in a hemodialysis program. The trace metal contents of bone biopsies with histological features of either osteomalacia, adynamic bone disease, mixed lesion, normal histology, or hyperparathyroidism were compared with each other and with the trace metal contents of bone of subjects with normal renal function. Trace metals were measured by atomic absorption spectrometry. RESULTS: The concentrations of aluminum, chromium, and cadmium were increased in bone of end-stage renal failure patients. Comparing the trace metal/calcium ratio, significantly higher values were found for the bone chromium/calcium, aluminum/calcium, zinc/calcium, magnesium/calcium, and strontium/calcium ratios. Among types of renal osteodystrophy, increased bone aluminum, lead, and strontium concentrations and strontium/calcium and aluminum/calcium ratios were found in dialysis patients with osteomalacia vs the other types of renal osteodystrophy considered as one group. Moreover, the concentrations of several trace elements in bone were significantly correlated with each other. Bone aluminum was correlated with the time on dialysis, whereas bone iron, aluminum, magnesium, and strontium tended to be associated with patient age. Bone trace metal concentrations did not depend on vitamin D intake nor on the patients' gender. CONCLUSIONS: The concentration of several trace elements in bone of end-stage renal failure patients is disturbed, and some of the trace metals under study might share pathways of absorption, distribution, and accumulation. The clinical significance of the increased/decreased concentrations of several trace elements other than aluminum in bone of dialysis patients deserves further investigation.     

Comparative in vitro activities of XRP 2868, pristinamycin, quinupristin-dalfopristin, vancomycin, daptomycin, linezolid, clarithromycin, telithromycin, clindamycin, and ampicillin against anaerobic gram-positive species, actinomycetes, and lactobacilli

A comparative study of the in vitro activities of XRP 2868, a new oral streptogramin, against 266 anaerobic gram-positive clinical isolates using the agar dilution method showed that the XRP 2868 MICs for 95% (254 of 266) of isolates were < or =0.5 microg/ml. XRP 2868 MICs for only two strains, one being Clostridium clostridioforme (MIC, 16 microg/ml) and the other being Clostridium difficile (MIC, 32 microg/ml), were >2 microg/ml. Depending on its pharmacokinetics and pharmacodynamics, XRP 2868 has potential for use against infections with gram-positive anaerobes and deserves further clinical evaluation.     

Absorption, distribution, metabolic fate, and elimination of pefloxacin mesylate in mice, rats, dogs, monkeys, and humans

Pefloxacin mesylate is well absorbed by the oral route. The antimicrobial activity in dog, cynomolgus monkey, and human plasma was essentially due to unchanged drug which respectively accounted for 64, 94, and 84% of the total activity (ratios derived from relative area under the curve [AUC] values). Half-lives ranged from 1.9 h in mice to 8.6 h in humans. Protein binding was weak, about 20% in plasma. Except in brain, concentrations in most of the organs and tissues tested in rats and dogs were higher than the plasma levels. Microbiological activity in urine was mainly due to pefloxacin and norfloxacin, the N-desmethyl metabolite. The norfloxacin/pefloxacin ratios were 0 in mice, ca. 1 in rats and dogs, 1.6 in cynomolgus monkeys, and 2.3 in humans. The principal urinary compounds were unchanged drug in mice, pefloxacin glucuronide and pefloxacin N-oxide in rats and dogs, norfloxacin and pefloxacin in monkeys, and pefloxacin N-oxide and norfloxacin in humans. The urinary recovery of identified metabolites was 29.5% of the dose in mice, 37.8% in rats, 36.3% in dogs, 26.5% in monkeys, and 58.9% in humans. Biliary excretion occurred and was extensive in rats and dogs, mainly as a glucuronide conjugate of the drug. In rat and human bile, the main active compound was unchanged pefloxacin.     

达芬奇机器人辅助腹腔镜泌尿外科手术的围手术期护理体会

目的 总结达芬奇机器人辅助腹腔镜泌尿外科手术的围手术期护理措施和效果。 方法 回顾性分析2010年3月至2012年9月采用达芬奇机器人手术系统治疗的45例患者的临床资料。包括达芬奇机器人辅助腹腔镜前列腺癌根治术、膀胱癌根治术、根治性肾切除术、肾部分切除术、肾盂输尿管整形术、肾上腺切除术、肾切开取石术、输尿管切开取石术等。对患者术前进行心理护理、术前准备;术后进行心理护理、严密的生命体征监测、呼吸道护理、切口和引流管护理、饮食护理、早期康复锻炼、采取积极措施预防并发症的发生等。 结果 1例肾部分切除术患者因术中损伤精索静脉而中转开放手术,其余手术均获得成功。3例患者术后发生高碳酸血症,5例患者术后发生尿瘘,1例患者发生淋巴瘘,均经相应处理后痊愈。中位引流管留置时间5天,中位导尿管留置时间9天,中位术后肛门排气恢复时间1天,中位术后下床时间2天,中位术后住院时间9天。术后随访3～30个月,患者均健在,无严重并发症发生。 结论 芬奇机器人辅助腹腔镜泌尿外科手术具有创伤小、出血量少、效果满意、并发症少和术后恢复快等明显优势,减轻了患者的痛苦,明显减轻围手术期护理工作量,降低护理难度和提高护理质量和效率,具有广阔的应用前景。